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The use of high-risk donors decreases one-year survival in high-risk lung recipients Matthew Mulligan, Pablo G Sanchez, Charles F Evans, Sina Rahimpour,

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Presentation on theme: "The use of high-risk donors decreases one-year survival in high-risk lung recipients Matthew Mulligan, Pablo G Sanchez, Charles F Evans, Sina Rahimpour,"— Presentation transcript:

1 The use of high-risk donors decreases one-year survival in high-risk lung recipients Matthew Mulligan, Pablo G Sanchez, Charles F Evans, Sina Rahimpour, Irina Timofte, Keshava Rajagopal, Aldo T Iacono, June Kim, James S Gammie, Bartley P Griffith, Si M Pham University of Maryland School of Medicine

2 Disclosure I have no conflicts of interest

3 56% of lung transplants used extended donors (Reyes 2010) Use not associated with reduced survival (Gabbay 1999; Bhorade 2000; Orens 2003; Meers 2010) Paucity of data on matching donor quality and recipient severity

4 Single Institutional review Use of extended donors not associated with reduced survival in extended recipients

5 High-Risk Donors & High-Risk Recipients Poor Outcomes Clinical Impression

6 We hypothesize that use of high-risk donors with high-risk recipients is associated with decreased 1-year survival

7 Methods Review of UNOS Database –2005-2012 –Post LAS 9,015 Transplant Recipients Inclusion: ≥18 years old Exclusion: ECMO, Re-transplants

8 High-Risk Donors Low-Risk Donors Low-Risk Recipients High-Risk Recipients Vs. Outcomes: 1-year transplant survival 1-year post registration survival

9 Donor Risk Stratification High-Risk Donors? Multivariable Cox- hazard regressions Deviations from ideal donor factors on 1-year transplant survival Bhorade et al. JHLT 2000 Standard Donor Criteria

10 Donor Risk Stratification Donor VariablesHR (95% CI) Age≥551.2 (1.1-1.5) Cigarette Use ≥ 20 P-Y 1.2 (1.0-1.4) Diabetes1.3 (1.1-1.6)

11 Donor Risk Stratification Donor VariablesHazard Ratio (95% CI) PaO2≤3001.0 (0.9-1.1) Abnormal Chest X-Ray0.9 (0.8-1.0) Purulent Secretions1.0 (0.9-1.2) Blood Infection1.0 (0.8-1.2) No association with 1-year survival

12 Donor Risk Stratification High-Risk Donors Age≥55 or Smoking ≥20 pack- years or Diabetes 24% (n=2,155) Low-Risk Donors Everyone else 76% (n=6,680)

13 Recipient Risk Stratification High-Risk Recipients? LAS≥60 associated with decrease in survival after transplant (Liu 2010)

14 Recipient Risk Stratification High-Risk Recipients LAS≥60 8% (n=679) Low-Risk Recipients LAS<60 92% (n=8,336)

15 OUTCOMES

16 1-Year Transplant Survival

17 Lower survival associated with high-risk donors in high-risk recipients Benefit of using high-risk donors over no transplantation? 1-year post registration survival

18 1-Year Post-Registration Survival Waitlist Mortality Candidates not transplanted

19 Summary Independent donor variables that affect 1-year survival – age≥55, smoking≥20 P-Ys, diabetes  High-risk Donor High-risk donors in recipients with LAS<60: marginal survival disadvantage High-risk donors in recipients with LAS≥60: markedly decreased survival Nevertheless high-risk donors into high-risk recipients: better survival than no transplant.

20 Conclusion First large database analysis demonstrating that matching donor quality with recipient status is critical to achieve optimal outcomes in lung transplantation

21 Thank You


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